In a study reported in the Journal of the National Cancer Institute, Herr et al found that patients with specific types of primary lymphoid neoplasms were at increased risk of second primary cutaneous melanoma, with the reciprocal association also being observed. Occurrence of second primary malignancy was associated with increased mortality risk.
The study involved a cohort of Caucasian adults from 17 U.S. population–based cancer registries consisting of 151,949 ≥ 1 year survivors of first primary lymphoid neoplasms and 148,336 survivors of a first primary cutaneous melanoma diagnosed between 2000 and 2014. Mean follow-up among patients with lymphoid neoplasms varied by type from 3.3 to 6.0 years.
The first course of treatment varied by type, with most chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL/SLL) patients having no known treatment and patients with other subtypes ranging in receipt of chemotherapy (33.5%–86.5%) and/or radiotherapy (1.3%–37.8%). Mean follow-up in patients with cutaneous melanoma was 5.4 years, and stage was most commonly localized with thickness ≤ 1.0 mm (62.5%).
Among patients with a first primary lymphoid neoplasm, second primary cutaneous melanoma risk was significantly increased after CLL/SLL (standardized incidence ratio [SIR] = 1.96, 95% confidence interval [CI] = 1.74–2.21), follicular lymphoma (SIR = 1.32, 95% CI = 1.09–1.58), and plasma cell neoplasms (SIR = 1.33, 95% CI =1.07–1.63). Among patients with a first primary cutaneous melanoma, second primary lymphoid neoplasm risk was increased for CLL/SLL (SIR = 1.44, 95% CI = 1.25–1.66), follicular lymphoma (SIR = 1.47, 95% CI = 1.21–1.77) and plasma cell neoplasm (SIR = 1.25, 95% CI = 1.06–1.47).
Risk for cutaneous melanoma was significantly increased after diffuse large B-cell lymphoma (SIR = 1.22, 95% CI = 1.02–1.45) and Hodgkin lymphoma (SIR = 1.75, 95% CI = 1.33–2.26), but neither of these lymphoid neoplasms conferred an increased risk for cutaneous melanoma. No significant associations were found between marginal zone lymphoma and cutaneous melanoma.
Development of a second primary cutaneous melanoma was associated with increased risk of mortality from any cause for CLL/SLL (hazard ratio [HR] =1.52, 95% CI = 1.25–1.85), diffuse large B-cell lymphoma (HR = 1.82, 95% CI = 1.30–2.55), follicular lymphoma (HR = 1.58, 95% CI = 1.11–2.27), and Hodgkin lymphoma (HR = 2.46, 95% CI = 1.45–4.16) but not for marginal zone lymphoma (HR = 1.19, 95% CI = 0.57–2.50) or plasma cell neoplasm (HR = 1.04, 95% CI = 0.73–1.48). Similarly, development of a second primary lymphoid neoplasm after cutaneous melanoma was associated with increased mortality risks, with the highest risks seen for plasma cell neoplasm (HR = 6.28, 95% CI = 5.00–7.88) and diffuse large B-cell lymphoma (HR = 5.06, 95% CI = 3.84–6.66), with somewhat lower risks associated with follicular lymphoma (HR = 1.75, 95% CI = 1.15–2.65) and Hodgkin lymphoma (HR = 3.64, 95% CI = 1.89–6.99).
The investigators concluded, “Heterogeneous associations between [cutaneous melanoma] and specific [lymphoid neoplasm] subtypes provide novel insights into the etiology of these malignancies, with the mutual association between [cutaneous melanoma] and certain [lymphoid neoplasms] suggesting shared etiology. Development of second primary [cutaneous melanoma] or [lymphoid neoplasm] substantially reduces overall survival.”
The study was supported by the Intramural Research Program of the National Cancer Institute.
Lindsay M. Morton, PhD, of the Division of Cancer Epidemiology and Genetics, National Cancer Institute, is the corresponding author for the Journal of the National Cancer Institute article.
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